Peritoneal Flap Hernioplasty Research Articles

Evaluation of risk factors associated with the peritoneal flap hernioplasty for complex incisional hernia repair - a retrospective review of 327 cases

BackgroundRepair of large incisional hernias is challenging, and the risks of postoperative complications have been associated with obesity, smoking, and diabetes. The present study was conducted to determine the impact of these risk factors on short and long-term outcomes following the repair with the peritoneal flap hernioplasty (PFH).MethodsThree hundred twenty-seven patients undergoing PFH for incisional hernia repair were identified. Patient demographics and clinical data were recorded. Patients presenting signs of complications were assessed during a visit to the outpatient clinic. A multivariable regression analysis was performed to evaluate the association between BMI, smoking and diabetes, and postoperative complications.ResultsThe study included 157 males (48.0%) and 170 females (52.0%). Median BMI was 30.9 kg/m2. Diabetes was present in 13.8% of patients. 23.2% were active smokers. The recurrence rate was 2.4%. The odds ratios for postoperative complications were increased by 9% per BMI unit (P < 0.01), due predominantly to a rise in superficial wound infections (P < 0.01) and seroma production (P = 0.07). The adjusted odds ratio increased fourfold in patients with BMI > 40 kg/m2 (P = 0.06).ConclusionIncisional hernia repair with the PFH technique is associated with a low risk of short and long-term complications. The risk is associated with obesity and significantly increased in patients with a BMI exceeding 40 kg/m2, where a fourfold increase was observed predominantly due to seroma and superficial wound infections. The recurrence rate was 2.4% and was unaltered across BMI categories. No association was established between smoking, diabetes, and the risk of all-cause complications.

Perforator Preserving Anterior Component Separation Technique Combined with Peritoneal Flap Hernioplasty in Patients of Complex Ventral Hernia

Perforator Preserving Anterior Component Separation Technique Combined with Peritoneal Flap Hernioplasty in Patients of Complex Ventral Hernia

AB078. SOH22ABS127. The ‘sandwich’ technique for large and complex incisional hernias: a retrospective review

Background: Repair of large incisional hernias is challenging as primary fascial closure often cannot be achieved. The peritoneal flap hernioplasty, or ‘sandwich’ incisional hernia repair (SIHR), serves to close the fascial gap by utilisation of the thickened hernia sac which also isolates the mesh from intraperitoneal contents and the subcutaneous space. We report outcomes from utilisation of this technique in our institution.

Peritoneal flap hernioplasty for repair of incisional hernias after orthotopic liver transplantation

BackgroundRepair of incisional hernias following orthotopic liver transplantation (OLT) is a surgical challenge due to concurrent midline and transverse abdominal wall defects in the context of lifelong immunosuppression. The peritoneal flap hernioplasty addresses this problem by using flaps of the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space, exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. We report our short and long-term results of 26 consecutive liver transplant cases with incisional hernias undergoing repair with the peritoneal flap technique.MethodsPost-OLT patients undergoing elective peritoneal flap hernioplasty for incisional hernias from Jan 1, 2010–Nov 1, 2017 were identified from the Lothian Surgical Audit system (LSA), a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in Feb 2020.ResultsA total of 517 liver transplantations were performed during the inclusion period. Twenty-six of these (18 males, 69%) developed an incisional hernia and underwent a peritoneal flap repair. Median mesh size (Optilene Elastic, 48 g/m2, BBraun) was 900 cm2 (range 225–1500 cm2). The median time to repair following OLT was 33 months (range 12–70 months). Median follow-up was 54 months (range 24–115 months) and median postoperative stay was 5 days (range 3–11 days). Altogether, three patients (12%) presented with postoperative complications: 1 with hematoma (4%) and two with chronic pain (8%). No episodes of infection or symptomatic seroma were recorded. No recurrence was recorded within the follow-up period.ConclusionRepair of incisional hernias in patients following liver transplantation with the Peritoneal Flap Hernioplasty is a safe procedure associated with few complications and a very low recurrence rate. We propose this technique for the reconstruction of incisional hernias following liver transplantation.

Peritoneal flap hernioplasty for reconstruction of transverse incisional hernias.

Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this problem using flaps of hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. The operative technique and long-term results of 80 consecutive cases with transverse incisional hernias undergoing repair with this method are reported. Patients undergoing elective peritoneal flap hernioplasty repair for transverse incisional hernias from Jan. 1, 2010 to Dec. 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in May 2019 from hospital records and telephone interview. 80 patients, (n = 53 male, 66%) were identified. Mean follow-up was 83months (range 55-114months) and mean postoperative stay was 6.4days (range 1-23days). Eleven repairs (14%) were for recurrent hernia. Mean mesh size applied (Optilene Elastic, 48g/m2, BBraun) was 747cm2 (ranged 150-1500cm2). Redundant skin excision was performed in 54% of cases. Altogether, seven patients (8.8%) presented with postoperative complications: five superficial wound infections (6.3%), one symptomatic seroma (1.3%) and one recurrence (1.3%) within the follow-up period. The peritoneal flap hernioplasty is associated with few complications and a very low recurrence rate. We propose this technique as the method of choice for reconstruction of transverse abdominal incisional hernias when primary fascial apposition is not possible.

Peritoneal Flap Hernioplasty for Reconstruction of Large Ventral Hernias: Long-Term Outcome in 251 Patients

BackgroundRepair of large ventral hernias is challenging when primary fascial closure cannot be achieved. The peritoneal flap hernioplasty, a modification of the Rives-Stoppa retromuscular mesh repair, addresses this problem by using the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space. It is applicable to both midline and transverse hernias. We report the results from our institution using this repair based on a retrospective review of 251 cases.MethodsPatients undergoing peritoneal flap hernioplasty repair from January 1, 2010–December 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively maintained computer database of all surgical procedures in the Edinburgh region of southeast Scotland. Patient demographics, clinical presentation, location of the hernia and surgical treatment were obtained from the hospital case-notes. Follow-up consisted of a clinical consultation 3 months postoperatively and a retrospective review of patient files completed December 2018. Patients presenting signs of complications were assessed during a clinical review.ResultsTwo hundred and fifty-one patients underwent incisional hernia repair, 68.1% in the midline and 31.9% arising through transverse incisions. Forty-three of these (17%) were recurrences referred from other centers. Mean BMI was 32.1 kg/m2 (range 20–59.4 kg/m2). Mean defect width was 9.2 ± 4.2 cm (range 2.5–24.2 cm). Mean mesh size was 752 cm2 (range 150–1760 cm2). Some form of abdominoplasty was performed in 59% of cases. Mean postoperative stay was 6.3 days (range 1–33 days). Mean follow-up time was 75 months (range 44–104 months). Fifty-three patients (21.1%) developed postoperative complications. Three (1.2%) developed superficial skin necrosis and 27 (10.8%) a superficial wound infection, but none developed deep mesh infection. Twelve (4.8%) developed symptomatic seroma and 11 (4.4%) a hematoma requiring surgical intervention. Seven (2.8%) patients developed recurrence within the follow-up period.ConclusionPeritoneal flap hernioplasty is an excellent and versatile method for reconstruction of large ventral hernias arising in both midline and transverse incisions. The technique is safe and associated with few complications and a very low recurrence rate.

Histological findings in equine testes one year after standing laparoscopic peritoneal flap hernioplasty

In order to know reproduction-related complications due to standing laparoscopic peritoneal flap hernioplasty, histological characteristics of the testicles from five stallions one year after surgery were compared with seven testicles...

Testicular perfusion after standing laparoscopic peritoneal flap hernioplasty in stallions

Acquired inguinal herniation is a very common condition in stallions, usually leading to unilateral or bilateral castration to prevent future recurrence. Recently, several surgical techniques such as the standing laparoscopic peritoneal flap hernioplasty (SLPFH) have been developed to avoid herniation recurrence and also preserve the breeding activity of high economic value stallions. However, studies on SLPFH lack more comprehensive and systematic data about reproductive-related adverse effects and outcomes. The aim of this study was to evaluate whether SLPFH of the internal inguinal rings produces changes in the testicular blood flow in a 1-year follow-up. For that purpose, six healthy stallions were used and testicular blood flow was assessed before, 3, 6, and 12 months (T0, T3, T6, and T12) after the procedure. Blood flow was evaluated ultrasonographically, using the pulsed-wave color Doppler mode. Peak systolic velocity, end-diastolic velocity, the time-averaged maximum velocity, and the derived indexes (resistive index) and pulsatility index) of the testicular artery were measured in two localizations: in the spermatic cord and on the caudal epididymal edge of the testicle. On the spermatic cord, the peak systolic velocity of the testicular artery increased significantly at T12. However, on the epididymal edge location of the artery, the pulsatility and resistive indexes were decreased at T12 (P < 0.05). This pattern of blood flow was related to a hyperemic process. Furthermore, SLPFH might have compressed the spermatic cord, causing a slight occlusion of the testicular artery and triggering a compensatory hyperemia to compensate the deficit of blood flow that supplies the testes. The SLPFH of the internal inguinal ring affected the testicular perfusion in stallions in a 1 year follow-up, although there was no effect on sperm production during this time. The spectral Doppler ultrasound is a useful tool to asses the testicular perfusion after reproductive surgical procedure and provides information which anticipates vascular supply compromise of the stallion testicles.

The peritoneal flap hernioplasty for repair of large ventral and incisional hernias

Mesh repair of large ventral or incisional hernias is problematic when primary fascial closure cannot be achieved, as this leaves mesh exposed, bridging the gap. We describe a modified retromuscular sublay repair which overcomes this problem and report a retrospective review of cases to assess outcome. Mesh is positioned between transposed flaps of preserved hernial sac and rectus sheath. Patients undergoing this repair by one author (BT) from 1 January 2004 to 31 December 2010 were identified, and clinical outcome was assessed by a combination of case-note review, outpatient consultation and telephone interview. Twenty-one ventral and incisional hernias were treated by this method. Eighteen were incisional (13 midline, three transverse and two oblique incisions), and three were primary paraumbilical hernias. Defect sizes ranged from 25 to 500 cm(2) and mesh sizes from 300 to 900 cm(2). Patients were reviewed at 6 weeks, 6 months and at a median of 37 months post-operatively. Three cases of superficial skin edge necrosis, two superficial wound infections and two sizeable seromas developed, but all had resolved within 6 months. One patient developed abdominal wall necrosis requiring mesh removal and eventual abdominal wall reconstruction without mesh, resulting in late recurrence. All other cases achieved excellent long-term outcomes with a high degree of patient satisfaction. This is a useful method for repairing large ventral and incisional hernias when primary fascial closure is not achievable, combining a sublay mesh repair with autologous tissue transposition across the fascial gap.

Evaluation of testicular perfusion with color and pulsed Doppler ultrasonography after “standing laparoscopic peritoneal flap hernioplasty technique”

Evaluation of testicular perfusion with color and pulsed Doppler ultrasonography after “standing laparoscopic peritoneal flap hernioplasty technique”

Standing Laparoscopic Peritoneal Flap Hernioplasty Technique for Preventing Recurrence of Acquired Strangulating Inguinal Herniation in Stallions

To describe a standing laparoscopic peritoneal flap hernioplasty (PFH) technique for closure of the vaginal ring, and to evaluate its effect on prevention of recurrent herniation in stallions, previously treated for acquired strangulating inguinal hernia (SIH). Case series. Stallions (n = 30) aged 3-15 that had previous acquired SIH. Bilateral standing laparoscopic PFH was performed on 30 stallions that had previous acquired SIH treated without castration. The vaginal rings were approached from 3 portals, 2 in the paralumbar fossa and a 3rd between the 17th and 18th ribs on the ipsilateral side. A large inverted U-shaped peritoneal flap was dissected from the abdominal wall proximal and cranial to the vaginal ring, reflected caudally over the vaginal ring, and secured to the abdominal wall with laparoscopic staples. In the first 11 stallions, only the cranial and mid third of the vaginal ring was covered. For the next 19 stallions, complete closure of the vaginal ring including the entire caudal aspect of the vaginal ring was achieved. SIH recurrence occurred in 4 of 11 stallions with incomplete ring closure whereas no SIH recurrence occurred when the entire vaginal ring was closed. No major complications occurred and cosmetic outcome was excellent. All breeding stallions were successfully used for breeding. Standing laparoscopic closure of the vaginal ring using a PFH is an effective way to prevent recurrence of SIH provided the entire vaginal ring, including the caudal aspect is covered by the flap. There seems to be no effect on subsequent fertility.

Laparoscopic Hernioplasty in Recumbent Horses Using Transposition of a Peritoneal Flap

To evaluate the efficacy of a laparoscopic peritoneal flap hernioplasty (PFH) to close anatomically the vaginal ring and to evaluate its protective effect in horses with a history of strangulated inguinal hernia (SIH) against future herniation. Prospective study. A first group of 5 ponies, 3 horses and 1 donkey with no history of SIH and a second group of 4 horses 'clinical cases' with a history of SIH. A laparoscopic PFH was effected on all horses under general anaesthesia. Peritoneum ventro-lateral to the vaginal ring was elevated and cut on 3 sides, separated from the underlying muscle, then inverted and attached dorso-medially and laterally to the parietal wall using intra-corporeal stitches (6 cases) or laparoscopic staples (7 cases). Animals of the first group (n=9) underwent a standing laparoscopy 7 days post-operatively to visualize the vaginal rings. Horses of the second group were followed to confirm the absence of re-herniation. The laparoscopic check-up showed that the vaginal ring had been effectively and completely covered in all cases except the first one. No adhesions was observed. In the four clinical cases, none of the horses have had a reccurence of SIH at the time of writing (6 months to 4 years). Laparoscopic hernioplasty on a recumbent horse is feasible by closing the vaginal ring with a peritoneal flap. This technique was efficient in our cases to prevent recurrence of SIH but more cases are needed. This technique may reduce inflammation and irritation of the spermatic cord, which could otherwise jeopardise the animal's breeding career. Laparoscopic PFH coud be used in horses with a history of SIH.